By Carole C. Schriefer, R.N., J.D., The Health Law Firm
A nurse practitioner from Corinth, Mississippi, turned herself over to the authorities on Friday, January 8, 2016. Tami Bivens-Johnson was indicted on three counts of Medicaid fraud by an Alcorn County Grand Jury. Bivens-Johnson’s charges constitute felonies and account for more than $3,200 in fraudulent claims for Medicaid benefits.
Her Alleged Crimes Against Medicaid.
The first of Bivens-Johnson’s counts alleged the nurse practitioner billed phone consultations as office visits. Phone consultations fall under telemedicine and therefore require their own set of current procedural terminology (CPT) codes separate from face-to-face visits. For more information on relevant CPT codes for phone consulting from American Medical News, click here. Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face consultations or examinations between patient and provider for providing medical care. Accordingly, states have flexibility in determining the following aspects of the practice:
(a) Whether to cover telemedicine;
(b) What types of telemedicine to cover;
(c) Where in the state it is covered;
(d) How it is provided and covered;
(e) What types of practitioners providing telemedicine may be reimbursed and whether such practitioner or provider is “recognized” and qualified according to Medicaid statutes and regulations; and
(f) How much to reimburse for telemedicine services, as long as such payments do not exceed Federal Upper Limits. For more information on Federal Upper Limits from Medicaid.gov, click here.
For more information on telemedicine from Medicaid.gov, click here.
The remaining two counts against Bivens-Johnson were for alleged claims filed for services while the nurse practitioner was out of state.
Penalties That May Ensue.
It was reported that if convicted, Bivens-Johnson faces a prison term of up to 15 years and $150,000 in fines. And while that’s a fairly hefty punishment all on its own, that may not be all. According to the National Association of Medicaid Fraud Control Units (NAMFCU), federal regulations stipulate that providers who are convicted of a program related offense are excluded from receiving funds from any federally funded health care program for a minimum of five years. This is the case whether billing as a separate health care provider or as an employee of any health care facility. This sanction can greatly impact convicted providers and the provider community alike.
For more information on fraud and abuse laws issued by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), click here.
Are you currently under investigation for suspected Medicaid fraud? Are you currently involved in a Medicaid audit?
Contact a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
The attorneys of The Health Law Firm represent health care providers in Medicaid audits, Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620.
“Corinth Nurse Charged With Medicaid Fraud.” Daily Journal. dJournal.com: 8 Jan. 2016. Web. 11 Jan. 2016.
“Telemedicine.” Centers for Medicare and Medicaid Services. Medicaid.gov: Web. 13 Jan. 2016.
About the Author: Carole C. Schriefer is an attorney and registered nurse. She practices with The Health Law Firm, which has a national practice. Its regional office is in the Northern Colorado, area. www.TheHealthLawFirm.com The Health Law Firm, 155 East Boardwalk Drive, Fort Collins, Colorado 80525. Phone: (970) 416-7456. Its main office is in the Orlando, Florida area.
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